Provider Demographics
NPI:1598924243
Name:ELLIOTT, TANIA (MD)
Entity Type:Individual
Prefix:DR
First Name:TANIA
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TANIA
Other - Middle Name:
Other - Last Name:MUCCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:560 WHITE PLAINS RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5113
Mailing Address - Country:US
Mailing Address - Phone:646-582-7024
Mailing Address - Fax:646-224-8524
Practice Address - Street 1:1200 WATERS PL
Practice Address - Street 2:SUITE 110
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2728
Practice Address - Country:US
Practice Address - Phone:718-863-4366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-07
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254590207R00000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400100839Medicare PIN